Considerations

Here are some questions that letting people use HRAs to pay for direct primary care arrangements may raise for players in the traditional health coverage community.

Will the arrangements help make primary care doctors happier, and their practices more profitable?
Will the arrangements hurt insurers' and health plans' efforts to protect enrollees from seeing bad providers, or providers who are lying about their credentials?
Will the arrangements cut down on health plans' ability to know which enrollees are on track to need inpatient hospital care, or expensive specialty care?
How will states or other agencies verify that the direct primary care practices have the resources needed to provide the services promised?
How can the direct primary care practices keep traditional insurers from unfairly trying to push expenses toward them, and how can traditional insurers keep direct primary care practices from unfairly trying to push expenses toward them?
Can a health insurer or employer plan buy and run a direct primary care practice itself, and simply combine the captive direct primary care practice with traditional health coverage?

Many states have exempted health care cost sharing ministries from most of the laws and regulations that apply to secular businesses. For members of the traditional health coverage community, the top question is how regulators can respect the ministries' religious freedom while increasing the odds that the ministries will work the way members expect them to work.

Instant Insights /

IRS proposes allowing use of HRAs to pay for direct primary care

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